It is usually, but not always, indicative of an otologic problem. Tinnitus is a term used to describe an internal noise perceived by the patient. If the tinnitus is bilateral, not particularly intrusive, not pulsatile, and associated with symmetric hearing loss, it is likely secondary to the hearing loss itself. If tinnitus is accompanied with hearing loss that is asymmetric or unilateral, this requires further evaluation with magnetic resonance imaging of the internal auditory canal to rule out acoustic neuroma. Slowly progressive unilateral hearing loss, tinnitus, disequilibrium.ĭiagnose with MRI treat with surgery or stereotactic radiation therapy Patient will be complaining of gradual hearing loss, tinnitus, balance disturbanceīenign tumor of the Schwann cells (the cells which produce myelin sheath) - most commonly affects the vestibular division of the 8'th cranial nerve. Fungal otitis externa is most commonly seen in immunocompromised patients, those with recent long-term antibiotic therapy, or in hot humid climates Oral fluconazole (B) is used for fungal otitis externa. Oral amoxicillin/clavulanate (A) is reserved for febrile patients or those with extensive periauricular soft tissue involvement. Since the tympanic membrane cannot be visualized to rule out a perforation, acetic acid should be avoided. Topical acetic acid 2% solution (C) is an accepted treatment for otitis externa, but is not safe with tympanic membrane perforations. Topical antibiotics (D) should be initiated after the debris has been removed. Oral antibiotics (C) are reserved for severe cases of external otitis that do not resolve with topical medications. Placement of an ear wick (B) is done when there is severe swelling of the ear canal to facilitate the entry of topical medications. This can be done with gentle irrigation as long as the tympanic membrane is intact. The debris needs to be removed to allow entry of the topical medication. The first step in the treatment is to irrigate the ear canal to remove debris. Physical exam reveals erythema and edema of the ear canal as well as pain with manipulation of the auricle or tragal pressure. Common symptoms include otalgia, pruritus, otorrhea and decreased hearing. Treatment is topical antimicrobials with or without steroidsĬomments: Necrotizing otitis externa - a complication seen in diabetics/immunocompromisedĮxternal otitis is inflammation of the external ear canal that is most commonly caused by bacteria.Įxternal otitis is also known as swimmer's ear as it commonly develops after water exposure. Most commonly caused by Pseudomonas aeruginosa PE will show pain with palpation of tragus/pinna Patient with a history of swimming or moisture exposureĬomplaining of malodorous discharge and pruritus
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